Provider Demographics
NPI:1053138230
Name:ALFARO, ANDREA (OD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALFARO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W WALNUT ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756-3297
Mailing Address - Country:US
Mailing Address - Phone:479-621-8391
Mailing Address - Fax:
Practice Address - Street 1:2110 W WALNUT ST STE 4
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3297
Practice Address - Country:US
Practice Address - Phone:479-621-8391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist